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Patient Factors Influencing Dermal Filler Complications: Prevention, Assessment, and Treatment

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Patient Factors Influencing Dermal Filler Complications: Prevention, Assessment, and Treatment Clinical, Cosmetic and Investigational Dermatology Dovepress open access to scientific and medical research Open Access Full Text Article REVIEW Patient factors influencing dermal filler complications: prevention, assessment, and treatment Koenraad De Boulle1 Abstract: While rare, complications do occur with the esthetic use of dermal fillers. Careful Izolda Heydenrych2 attention to patient factors and technique can do much to avoid these complications, and a well-informed practitioner can mitigate problems when they do occur. Since cosmetic surgery On behalf of the Consensus is usually an elective process, requested by the patient, clinical trials are complex to organize Group and run. For this reason, an international group of practicing physicians in the field of esthetics came together to share knowledge and to try and produce some informed guidance for their 1Aalst Dermatology Group, Aalst, colleagues, considering the literature and also pooling their own extensive clinical experience. Belgium; 2Cape Town Cosmetic Dermatology Centre, Century This manuscript aims to summarize the crucial aspects of patient selection, including absolute City, South Africa contraindications as well as situations that warrant caution, and also covers important consid- erations for the pre- and posttreatment periods as well as during the procedure itself. Guidance is given on both immediate and long-term management of adverse reactions. The majority of complications are related to accepting patients inappropriate for treatment or issues of steril- ity, placement, volume, and injection technique. It is clear that esthetic practitioners need an in-depth knowledge of all aspects of treatment with dermal fillers to achieve optimal outcomes Video abstract for their patients. Keywords: dermal fillers, complications, prevention, assessment, treatment, patient factors Introduction A wide range of dermal fillers is now available for use in facial esthetics.1 All are potentially capable of causing complications,2,3 but fortunately, serious occurrences are rare, although probably underreported. Careful attention to patient selection, education, and injection technique can minimize the incidence of complications, and an understanding of the early signs of complications and their proactive management can decrease their impact. Point your SmartPhone at the code above. If you have a Selecting appropriate patients, or perhaps more importantly, not treating inappropri- QR code reader the video abstract will appear. Or use: http://dvpr.es/1G2e9Uh ate patients, is the first and a crucial step in avoiding complications with dermal fillers. This review considers the factors that should be borne in mind when assessing a patient for suitability for dermal filler treatment. It aims to give the practitioner an overview of contraindications, preventative measures, recognition of events, and appropriate treatment options. There remains, however, no consensus on the best treatment for adverse reactions, and each treatment option with its advantages and disadvantages should be carefully considered and discussed with the patient.4 Correspondence: Koenraad De Boulle Aalst Dermatology Group, Cosmetic surgery is usually an elective process, requested by the patient. As such, Leopoldlaan, 43, 9300 Aalst, Belgium clinical trials are complex to organize and conduct. For this reason, an international Tel +32 53 781 899 Email [email protected] group of practicing physicians in the field of cosmetic surgery came together to share submit your manuscript | www.dovepress.com Clinical, Cosmetic and Investigational Dermatology 2015:8 205–214 205 Dovepress © 2015 De Boulle and Heydenrych. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted http://dx.doi.org/10.2147/CCID.S80446 without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php De Boulle and Heydenrych Dovepress knowledge and to try and summarize what is published and of an underlying mental disturbance or dysmorphophobic produce some informed guidance for their colleagues. This tendency. manuscript is the result of preparation, study, and discussion Well-focused pretreatment photographs should be taken, among the group and is based on the literature as well as the not only for assessment of treatment effects and any adverse group’s clinical experience. The authors acknowledge that effects but also for medicolegal purposes.5,6 this guidance is based on the collective experience of the The patient’s medical history and subsequent evaluation group at the time of writing, but it is not definitive, and there must be comprehensive, and patients should be advised is a paucity of previously published data in many areas. to include cosmetic treatments when giving their history. de Bree et al7 reported on a patient who received polyacryl- Methods amide gel and developed a paranasal granuloma. The authors The first author regularly receives queries and referrals relat- emphasized that the patient did not disclose her cosmetic ing to complications with dermal fillers, with an increasing treatment history, which confounded the diagnosis. proportion originating from outside the major EU countries. The suitability of different fillers needs to be discussed, A round table meeting was convened with interested physi- and the patient given an indication of the likely value that can cians from some of these countries to discuss adverse events be obtained from treatment.2,6 Soft tissue augmentation is an associated with dermal filler treatments and the training elective procedure, and not all those seeking treatment may requirements for injectors. be suitable candidates on medical grounds. It is important to Patient selection emerged as a core topic of concern, avoid treating patients who have preexisting conditions that and in the light of the lack of information, the delegates clearly mandate against the use of dermal fillers Table( 1). wished to collate their experience in avoiding complications. This is a crucial and often neglected area of esthetic practice. Subsequently, the authors developed this consensus paper Other patients may be somewhat dubious candidates, where based on those discussions and a review of the current treatment must be at the discretion of the physician whose literature. informed judgment is paramount. PubMed and Ovid Medline databases were searched using A convenient way of considering patient-related factors terms of “complications” OR “soft filler complications” OR is as skin-related or systemic factors. A clear link needs “injectable complications” AND “dermal fillers”. Papers to be made between the two to ensure that the patients are from 2005 were selected (although older papers may be forthcoming about all conditions or treatments, even if they referred to in discussions where relevant). References cited believe them to be completely unrelated. in selected articles were also reviewed to identify additional Firstly, contraindications detailed in the instructions for relevant reports. use of the chosen filler should be closely adhered to. These Because of the nature of esthetic procedures, where mainly refer to the product constituents or excipients; patients patients are not referred, but elect to have treatment by the with multiple or severe allergies and those with a history of practitioner of their own choosing, it is challenging to devise anaphylaxis should not be treated. meaningful clinical trials. Some authors have conducted Similarly, where data are available on a particular product prospective trials, but these are the minority of studies or technique, the physician should take care not to extrapolate and are often not randomized or controlled. Therefore, our the results or assume that they are transferrable. This includes knowledge base comprises case reports and summaries of results obtained only in one area of the anatomy.8 individual practitioner’s experience. This underlines the need Prospective patients with abnormally thin skin or skin to gather consensus views from experienced injectors who atrophy, such as seen in corticosteroid-induced atrophy of the have treated many patients. skin due to long-term topical or peroral steroid use, or with conditions such as anetoderma, vermiculate atrophoderma, or Pre-procedure considerations rheumatoid arthritis-associated skin thinning of the dorsum Patients’ expectations must be managed, so they do not of the hands, are not suitable candidates for superficial or envisage an unrealistic outcome, and they must be made medium-depth placement of certain fillers. Very thin skin aware of the limitations and risks of dermal fillers. The treat- on the eyelids and in cheeks that have many fine wrinkles is ment of inadequately informed patients can be fraught with also a contraindication for certain fillers.9 problems and may cause dissatisfaction.5 Caution should be Infections in, or adjacent to, the region to be treated can exercised when confronting an individual who exhibits signs be exacerbated and cause complications, since the infecting 206 submit your manuscript | www.dovepress.com Clinical,
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